Aug. 27, 2024 – Osteoarthritis is a pain – literally. In many cases, it can make it difficult to walk or get up from a sitting position, and may mess with your sleep and daily activities, especially when it affects the knees.
Researchers project that by 2050, knee osteoarthritis cases will increase by almost 75% globally. Although there is no cure, there are things that people can do to get moving again, often without pain and discomfort. The key is to catch it as early as possible.
“I tell patients that once it starts, we can’t stop or reverse it; we can’t do anything to put more cushion back in the knee,” said David A. Wang, MD, a primary sports medicine specialist at the Hospital For Special Surgery in Paramus, NJ, and assistant attending doctor at the Hospital for Special Surgery in New York City. “The best thing we can do is try to slow its progression over time.”
Changing Risk Demographics
One of the most important risk factors for knee osteoarthritis is age; the disease often makes itself known in adults ages 45 and older as the cartilage – the tissue that pads your bones – wears out. But the role that age plays may be changing.
“While age is a major factor, there is a trend of onset shifting to younger individuals,” said Alison H. Chang, a physical therapist and professor in the Department of Physical Therapy and Human Movement Sciences at the Feinberg School of Medicine at Northwestern University in Chicago.
“The vast majority of knee OA patients are older, but we see it in people in their 40s, even in their 30s,” Wang said. “I think that the main reason is previous injury; we are seeing a lot more of an epidemic of ACL [anterior cruciate ligament], which is a definite risk factor for arthritis.”
Other things that can lead to knee osteoarthritis include previous surgeries, higher weight, and disorders of the joints, such as being bowlegged, Chang said.
Move It or Lose It
Researchers have long studied the role of physical and weight-bearing activities in the development and worsening of knee osteoarthritis. Recently, Chang did a study to find out if specific activities, like jogging, swimming, cycling, tennis, aerobic dance, and skiing, or extensive sitting patterns would lead to signs of knee osteoarthritis over an 8-year period in adults.
Not only was strenuous activity not linked to signs of the disorder, but the findings suggested that doing strenuous activity in low and moderate amounts (for example, 1-2 hours per week) might actually protect against it.
On the other hand, although extensive sitting and lack of physical activity did not appear to significantly increase the risk of knee osteoarthritis, those who sit for long periods also tend to have other risk factors, including high body mass index (BMI), older age, more severe knee discomfort, and weak quadricep muscles.
But for people who are at risk or have already been diagnosed with knee osteoarthritis, balancing sitting and physical activity is important.
“I’m concerned about people at both extremes: Those who are super sedentary, and those who are highly active. Sometimes highly active people have the mindset that they must push through no matter what,” Chang said.
Wang agreed, explaining that as someone who grew up playing sports, he had long followed the saying “no pain, no gain.”
“As a sports medicine doctor, I know that that’s the worst thing that you can do; I tell patients that pain is your body’s way of telling you that something is wrong,” he said. “There’s a cliché doctor joke that I share: if it hurts, don’t do it.”
Knee Bone's Connected to the Thigh Bone …
Everything is interconnected in the body: the joints, muscles, and ligaments work together to perform movement.
“If one thing is off at the chain, something else is going to see more load,” Wang said. “If you have weak or stiff ankles, that’s going to put more load through your legs, your knees, the quads, the glutes – which specifically play an important role in stabilizing the hip and lower extremity,” he said.
Chang said maintaining muscle strength helps keep the joints stable and helps absorb shock when you're jumping or running.
Regardless of where you are in your knee osteoarthritis journey, it’s important to first speak with your doctor to learn what activities you should and shouldn’t be doing. A physical therapist will examine the entire lower limb chain to identify any potential issues, and also tailor a program that not only includes structured exercises (for example, cycling or strength training), but also, less vigorous physical activities, such as walking or housework.
And “a PT can be helpful for understanding and processing pain, ensuring that patients understand that pain doesn’t always equal harm or tissue damage,” Chang said.
Acknowledging a personal bias, Gary Campbell, a certified senior fitness instructor, cannot recommend engaging a personal trainer enough.
“I can pick stuff up right away and provide an alternative way of doing things to compensate for any injuries or pain,” he said. “I have the best job in the world; every day, I have clients tell me that they stopped taking medications or that they completed a half-marathon.”
“It’s never too late,” said Wang. “You won’t become a bodybuilder in your 80s or 90s, but you can still try to improve your strength and function at any age.”
Overcoming Fear
The Arthritis Foundation highlights the important connection between pain and the brain. When pain strikes, the nervous system sends signals to the brain, which in turn figures out the degree of danger to the body and then may pump up the pain quotient. Many people tend to avoid the pain at all costs, leading to fear of movement.
“I think for people over 50 that have injuries or any kind of debilitating condition that they’re less likely to go to the gym; there’s fear that they have to get over when asked to do something with their knees,” said Campbell, founder of the AgeFit 50+ Community on Facebook .“The challenge is that they tend to favor one leg over the other [and as the other leg gets worse], they start to gain weight because they’re doing less exercise, and that puts even more pressure on the knees,” he said.
Campbell, based in Québec, said he tells clients that as they get older, the tendons, ligaments, and muscles become less efficient, lose strength and “rattle."
“What we want to do is strengthen those muscles around the knee so that they tighten and support the joint,” he said. “If there’s pain, I ask clients to go to the pain, not into the pain, and over time, they learn where their stop points are before the pain hits.”
Correction: An earlier version of this story incorrectly referred to physical therapist Alison H. Chang as Alice H. Chang.
